M.Sc. (Med. (Bioethics and Health Law)), Faculty of Health Sciences, University of the Witwatersrand, 2008. / The research aims to establish whether processes around the consideration and execution of the living will help enhance the doctor-patient relationship. Studies have shown that the living will is not used frequently, and that the doctor-patient relationship is often deficient. The research explores the two primary topics – the living will, and the doctor-patient relationship – separately. Each primary topic is approached via a consideration of the relevant literature, and each is then analyzed from a theoretical–ethical point of view. A synthesis of these separate investigations is presented. This synthesis concludes that the living will can help enhance the doctor-patient relationship.

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AIDS Saskatoon, considered as a health social movement, is the focus of this research. It uses notions of life-world, system and life-world colonization as well as the typology of politics introduced by Cohen and Arato to answer the questions:<p> Why did AIDS Saskatoon emerge?<p> Is AIDS Saskatoon a defensive or an offensive social movement?<p> The defensive movements action is directed inward to the lifeworld and civil society, while the offensive modes of movement activism directed outward to state and economic institutions. With regards to the first question, I argue AIDS Saskatoon was formed as a reaction to patterns of the colonization of the life-world of people living with HIV/AIDS. Relative to the second question AIDS Saskatoon is seen to be a creative response to the colonization process that takes an organizational form conducive to both defensive and offensive dimensions.<p> Data for this study were derived from ten qualitative interviews were conducted - five with individuals diagnosed HIV/AIDS positive, three with the AIDS Saskatoon administrative staff, and two with the founders of AIDS Saskatoon.

AIDS Saskatoon, considered as a health social movement, is the focus of this research. It uses notions of life-world, system and life-world colonization as well as the typology of politics introduced by Cohen and Arato to answer the questions:<p> Why did AIDS Saskatoon emerge?<p> Is AIDS Saskatoon a defensive or an offensive social movement?<p> The defensive movements action is directed inward to the lifeworld and civil society, while the offensive modes of movement activism directed outward to state and economic institutions. With regards to the first question, I argue AIDS Saskatoon was formed as a reaction to patterns of the colonization of the life-world of people living with HIV/AIDS. Relative to the second question AIDS Saskatoon is seen to be a creative response to the colonization process that takes an organizational form conducive to both defensive and offensive dimensions.<p> Data for this study were derived from ten qualitative interviews were conducted - five with individuals diagnosed HIV/AIDS positive, three with the AIDS Saskatoon administrative staff, and two with the founders of AIDS Saskatoon.

The purpose of the present study was to begin to develop an understanding of how primary care resident physicians work with patients with personality disorder-type characteristics and processes. Participants include fifteen primary care resident physicians from a community health clinic. Participants individually viewed two video vignettes of an actor-patient being interviewed by a physician. Participants were asked how they would respond to statements the actor-patient made during the course of watching the video and then answered general questions about reactions to the actor-patient and working with patients with personality disorders. Using a naturalistic qualitative analysis, data were analyzed for categories and themes. The results of the analyses are presented within a basic framework for understanding how primary care residents work with and approach the doctor-patient relationship, and treat patients with personality disorder characteristics and associated personality processes. Broad themes emerge from the data. Content of residents' responses suggests two response styles: attention to patient's presenting physical concern or identify and potentially address underlying psychological and emotional concerns. Residents characterize the establishment of a relationship with this patient population as either a distancing, paternalistic approach, or an engaging and collegial relationship. Levels of self-awareness of reactions to patients consist of either a willingness to address personal reactions or a tendency to not identify or discuss those reactions. Residents also demonstrate a dichotomous response to willingness to work with this patient population characterized by either hesitancy to do so, or a desire to engage and attempt to work with these patients. A framework for understanding the possible effects and motivating variables behind these styles is presented. The predominant effects of the residents' interactions styles are either a distancing/paternalistic relationship or an engaging/collegial relationship. Two themes appear to characterize residents' motivations: the resident was driven by self-needs or patient-needs. These results may be useful in developing an initial theory of this previously unexamined dynamic. Moreover, these results may be useful in helping physicians better develop relationships with patients, especially through improvement in recognizing and utilizing personal reaction to patients. Future inquiries directed towards understanding what physician variables contribute to these two basic interaction styles identified here may be useful.

Background: Informed consent is the autonomy of the patient who involves decision-making after being informed of and understanding the physician. Objectives: This study sought to investigate and compare patients¡¦ and physicians¡¦ perceptions of informed consent and the factors that influence their viewpoints on informed consent. Methods: The subjects were citizens without medical background and physicians working in four hospitals. Self-structured questionnaire was used to gather information. The physicians were recruited from two medical centers, a regional hospital and a district hospital in Kaohsiung. The data is analyzed by SPSS 14.0 and used descriptive statistics, item analysis, factor analysis, chi-square test, Fisher's exact probability test, t-test, and ANOVA. Results: The response rates were 97% in citizens (n=891) and 79 % in physicians (n=158). As for the concept of informed consent, 55.7% citizens thought that doctor should respect the opinion from the patient and family during the informed consent process. Furthermore, 91.2% the citizens prefer to know the information about their health condition from the physicians rather than from family (8.8%). Regarding the sequence of informing the physical condition, 29.9% citizens also prefer directly from the physician. As for the decision-making process, 55% respondents thought that patient¡¦s own decision is the most important. 52.5% physicians thought that doctor should respect the opinion from both the patient and family and the bad news should be informed by physicians (88.0%) rather than by family. As for the sequence of knowing the bad news, 46.2% physicians preferred to inform family first and inform patient after discussing with family. In decision-making process, 48.7% physicians thought that physician¡¦s opinion was still more important than opinion of patients and family. Further analysis revealed that patients¡¦ gender and the level of family visited hospital have significant difference on the perception of informed consent (p=0.027; p=0.000); gender, age, educational background and living locations also have significant difference on ¡§who to deliver the bad news.¡¨ (p=0.006; p=0.004; p=0.035; p=0.012); Citizens¡¦ age, educational background and career have significant influence on their opinion of informed consent of recently visiting doctor (p=0.014; p=0.006; p=0.001). The variables in the physicians¡¦ background have no relation with the means of informing and decision-making. The gender and position of the physician have significant effect on the opinion of practice of informed consent (p=0.015 and p=0.001). Conclusions: We concluded that the perceptions of informed consent, there was no difference between physicians and citizens; however the citizen chose the patient first, and the physician chose the family first during the process of informed consent. Physicians have better perceptions of informed consent than the common citizens.

Fibromyalgi (FMS) är ett syndrom som främst karaktäriseras av kroniska smärtor i olika delar av kroppen. Patienter med FMS upplever ofta skepsis och misstro i mötet med vården på grund av att deras symptom är osynliga. Samtidigt kan det vara svårt för sjuksköterskor och övrig vårdpersonal att veta hur de ska förhålla sig till en sjukdom som inte uppvisar några kliniska fynd och vars etiologi fortfarande är relativt okänd. Dessa omständigheter gör vårdrelationen komplex. Syftet med denna studie är därför att utforska hur vårdrelationen upplevs mellan patienter med FMS och sjuksköterskor. 11 artiklar har analyserats, ur vilka ett huvudtema, fyra teman och två subteman identifierades. Resultatet visar att brist på tid, kunskap och förståelse resulterar i en problematisk vårdrelation. Betydelsen av att vårda dessa patienter i ett multiprofessionellt team framgår även. I diskussionen utvecklas på vilka sätt patienter med FMS och sjuksköterskor upplever vårdrelationen olika. Sjuksköterskornas känslor av maktlöshet kan från patientens sida istället uppfattas som ointresse och brist på engagemang, vilket kan medföra att patienterna tar med sig negativa känslor in i nya vårdmöten.

<p>Today patients are more aware of their rights regarding their own care. They are more informed, more engaged and have more and individual requirements, which leads to increased demands for information and participation increases. The Health Act sets out the patients´ right to participation. Participation increases patient satisfaction with care, promotes healing and increases adherence to health care advise. The patient doesn´t always experience participation in their own care to the extent they wish, which suggests that nurse’s does not always succeed in getting the patient involved. The purpose of this study is to describe factors that are important for patient participation in nursing care in a nurse- and patient perspective. Nine research articles were analyzed with qualitative content analysis. The analysis resulted in two themes: health care relationships and communication. Through various acts of nursing care, patients experienced themselves as being seen and confirmed. Patients experienced a sense of security and trust, which is the essence of a trusting relationship, which in turn is the basis for caring and patient participation in their own care. Patient participation requires a sophisticated interaction between nurse and patient, a quest of a safe relationship that can lead the patient to see themselves seen and confirmed.</p><p> </p><p> </p><p> </p><p>Keywords: patient participation, nurse-patient relationship, nurse, care</p>